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<br />
<br />RequIsition Number
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<br />V9ucher Number,
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<br />APPROVED:
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<br />Quantities AccePt~d
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<br />"i.:
<br />
<br />Date Received
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<br />Received At
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<br />I,
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<br />Pureh&8e Order No.
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<br />RECEIVIt ] REPORT
<br />/ ,'i ~ " 'STATE.o~<.;OLORADO "..';
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<br />""~/,' '- DEPARTMENt NSTITUnONORAGENCY
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<br />, ADDRESS
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<br />Fund Number
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<br />Supervisor
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<br />~~P~IO!"O!~lCle8orSen.'!'?88~~~Uy'R~el~~ i,
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<br />exceptions Noted
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<br />I hereb'ycertlfythat I have received the artlc18s"lIsled sbove, that I have carjOlfuUy Inspected, weighed,
<br />counted'or measured the commodltles and found them In-good conditlo'n and complying with the
<br />apeclflcatll:m., glv8n, ort~at the servlc~s were satisfactory, except aa noted.
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<br />R~elvlng Clerk or AuthoTlzi;ld Employee
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<br />VJa;Fr't D Exp.DP.P:OTruck DOther
<br />395'51000'1227
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